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New NICE guideline on diabetes in children and young people

This guideline recognises the increasing incidence of diabetes in this age group, the majority of whom have type 1 diabetes, although a small group will have type 2 diabetes. The guidance recommends attempting to reach an HbA1c level near the normal range, suggesting that tight control can be achieved by intensive insulin management accompanied by carbohydrate counting. Patient-centred care and careful communication is recommended, as is having five capillary blood glucose tests per day and using real-time continuous glucose monitoring, where appropriate.

By Colin Kenny, GP, Dromore

This guideline (NG18) updates and builds on the elements of CG15 relating to diabetes in children and young people, and it continues to acknowledge that this age group has specific care requirements. The guidance applies to both type 1 and type 2 diabetes in this age group, recognising that type 2 diabetes is much less common but has unique management needs. The guidance underlines the importance of good communication with individuals and their caregivers, as well as clear goal setting.

Tight glycaemic control to near normoglycaeamia is advised, along with regular, accurate blood glucose monitoring. Specifically, the guidance suggests an HbA1c target level of 48 mmol/mol (6.5%), and it provides clear guidance on hypoglycaemia and testing for ketonaemia. Clear advice is also given about diabetic ketoacidosis, particularly reduced consciousness, as well as immediate referral for this and first diabetes diagnosis. Finally, there is strong guidance about the importance of initial and ongoing tailored education for individuals and their caregivers, along with quarterly follow-up.

To access the full guideline, click here

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